I received the following letter from a consultant-addressed to my GP- following my aborted angiogram of last week. It’s fair to say that since I read it this morning I have had steam coming out of my ears, not to mention chest pains. I would value any feedback and advice how to proceed:
“Mr [..] has twice now attended for invasive coronary angiography and due to his ongoing anxieties and multiple questions it [sic] has not proceeded”.
In fact, on the first occasion the angiogram had not gone ahead because I had not paused Apixaban.On the second occasion, I was told I could not have a sedative which was a primary reason for the decision not to go ahead.
The letter continues: “ I think therefore that we are not going to be able to offer him suitable investigation and my wisest way forwards for him would be to presume he does have coronary disease in view of the echocardiogram and ECG findings and treat him accordingly with primary prevention medications including the Apixaban he is already taking. I would suggest he is switched from his use of Sotalol to Bisoprolol 5mg once daily.”
First of all, the hospital obviously *could* offer another procedure with sedation if it wanted to. And it seems absurd to say that you cannot have a procedure because of anxiety and asking multiple questions. To ask someone to presume they have a condition when they may not seems potentially dangerous. I certainly wouldn’t want to risk switching from Sotalol to Bisoprolol without having a proper diagnosis and an explanation of why it was necessary, particularly as the Sotalol is working well at the moment. The consultant has not given me any feedback on the abnormal angiogram which was taken on the day. I wondered what anyone thinks of this letter. The most immediate worry is that the GP could switch me to Bisoprolol on the recommendation of the consultant. Can I insist they continue with the old medication? What are the problems with Bisoprolol, if any? Can I insist on being referred to another hospital?
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115 Replies
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Hello
I feel you have not been treated right at all
I had to have my first angiogram aborted due to my severe anxiety that I have always had and the Consultant at the time said I was in such a state to try and attempt one would be dangerous
I did go on to have another heart attack even though they were hoping the meds I was on would prevent this
After the 2nd heart attack they sat me down and asked what they could do to help me get an angiogram done
I told them if I could be shown around , talked through it a week or so before and they made sure I had sedation this would all help
They did just that and yes I was anxious but because I knew what to expect they managed to do it and a good job I needed a triple Bypass and quick !
I personally would put a complaint in to Pals and say you are anxious but because you are you want the same treatment as everyone else and should reasonable adjustments not be made so you can have this procedure or are they going to gamble with you because you are anxious which if the case is discrimination
As for Bisoprolol that is a mixed bag of reviews from members some suite it some don't but you would have to try it to see how you are on it you could be fine
I do not think your Doctor can make you take it but if the Consultant has recommended it they will strongly advise you to
By the way after my abortion of the angiogram etc when I did have it done it was nothing like I expected it to be my anxiety had blown it up to be something so much more and if I managed it anyone can but you have a right to at least some sedation and I would ask my Doctor to refer me back again requesting I am given sedation to enable me to get this done
Good luck and let is know how you get on x
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Thanks for your reply. I think you are right about their decision not to offer treatment on account of anxiety. I was prepared to have the procedure but the absence of sedation made me reluctant to have it.
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The letter says they would do it with sedation if you wanted to try again and honestly I am a wreck but it is not that bad at all and I think it is better to get a full look at your heart than guessing they have got it right
If I were you I would tell my Doctor to ask them to do it with sedation Let us know what you decide x
The comment that the procedure couldn’t be done because of ‘multiple questions’ is, on the surface, pretty shocking! ..But, if it’s because the questions were being posed immediately before the angiogram, that would make sense as the team (and the ‘theatre’) would be under heavy pressure/schedules; the vast majority of questions should be addressed beforehand with your Cardiologist &/or their teams & GP’s.
I have a couple of questions though: were you told to ‘pause the Apixaban’ beforehand, and if so, why didn’t you? Secondly, why couldn’t you have the sedative? 🤔
I was told to pause the Apixaban about a month before the first procedure. They didn't criticise me for this however. They just said "it happens" at the time. The sedation was not allowed for the second procedure because I had not arranged to stay with someone for 24 hours. They didn't tell me about this in advance. I had pointed out at the pre-assessment that just before the procedure would not be a good time for me to ask questions as a) the doctor would be under time pressure and b) it's difficult to make a decision on the spur of the moment. They just repeated "ask the doctor on the day". I'm concerned about the switch of medication which, as you say, the GP may be reluctant to ignore.
I have to be honest and say how baffled I am at the letter you write and again, honestly amazed at some of the replies. I would like to emphasise I am writing this reply with the knowledge of some of the replies and the responses you have written to them: -
When people write in to this forum, we the readers have to take the letter verbatim and reply with honesty and compassion - usually! I too have had a letter from a consultant after a consultation that has ruined months of work with another consultant, by offering his opinion "out of context" and was why I was drawn to your letter in the first place,
Having begun, I was drawn to your plight with a great deal of mixed emotions but now with more information, here are my comments.
I go back to the first line of my second paragraph. You write and ask for advice without your being honest with the very audience you write to. The first procedure could not go ahead because you did not do as was asked and stop medication prior to the day.
As for sedation, I had it but "thought" I had not, based upon the knowledge I was awake. They told me afterward that I had been given sedation and was quite peaceful during the procedure and just because I was not out, was not proof of not being given sedation.
On the second appointment, we find out from further answers that the procedure was canceled because there would be no one available at home to look after you - a pre-requisite of the procedure if sedation is asked for. This is clearly stated in the documentation sent out with the appointment - for everyone!
There is no point in my going further for without telling the whole truth, you prevent a true reply. My true reply would seem harsh to one and all, but question why you wrote in the first place, suffice to say "as you sow, so shall you reep!
I fully agree with all your comments. We cannot make a judgement without first being told the full truth.
As for being told to stop medication prior to the op one MUST follow the medical instructions to the letter or face the fact that the procedure will not be carried out.
I have just had a major sinus operation and I was informed that I must stop taking all my OTC vitamins. I’d didn’t question why, but I stopped taking them immediately. I read all the leaflets and information which the hospital sent to me prior to my surgery date and I followed their rules to the letter. This operation meant so much to me that I did not want there to be any reason whatsoever for it to be postponed.
On having my first angiogram I was told to stay with someone or have someone come and stay with me. As I live on my own I stayed with my sister and her family.
Actually, I've just sorted out the notes I've kept about my husband's angiogram. I clearly states (and this is 4 years ago now), that the patient should not drive and should have someone with him for at least 24 hours after the procedure.Hubby didn't have sedation but did come off the tablets he was told to before the procedure went ahead.
Well, it's hubby who had the quad bypass so he's fine apart from the very low moods he has suffered since the op! I'm just plodding along with type 1 diabetes and cancer (as you do) and like you, we take each day as it comes!! Love and hugs. Jan xxx
Back at you, enjoy life!! I am off to the Speedway in Cardiff next Saturday first time ever with a friend who is coming to stay from Scotland. My first BIG event since (you know what) I am mentally preparing to get it and have planned accordingly. Take care.
After my second stent, as an outpatient, they had no overnight beds and decided that having an emergency alarm offset the fact that I live alone.
I had to carry the overnight bag I'd taken down to get the taxi. The taxi's driving almost gave me another heart-attack and I was dumped at home to order myself a take-away.
Good God that’s scary! 😳 I’m sure some taxi drivers are put out there to give us unofficial Heart Stress Tests on a random basis!! 😉 🚘 😆 Hope you’re doing well.. 👍
I believe the 24hr thing is in case they have to go in through the femoral archery and you start to bleed. I've had 2 angiograms. It's really no big deal. The first was through the femoral archery and it was specified that someone should be with me for 24 hours. The second was very recently as a pre cursor to mitral repair and that was through wrist. That only required a wrist clamp to apply pressure to the wound for a couple of hours. I didn't have (or need) sedation on either
Yes, I’ve had 4 angiograms (& stenting), 2 via the femoral artery & 2 via the radial artery (in the wrist) including sedation.🏹 😉
I asked them questions about the procedure at the pre-assessment. There were a number of (to me) important questions mostly relating to AF and bleeding risk which they said I should ask just before the procedure. I actually said this wasn't a good time.
I cannot tell you what procedurally you can or cannot do, however I do believe if you don't ask you don't get.
I would start off making an appointment with your GP so you can talk through the letter, presumably the initial referral came from them.
Hopefully they may be able to advise you how to proceed as I guess the ball has to start off with them in the first place.
In some ways I can see why the consultant said to treat you as if you have coronary disease as they are basing this from the tests you have had done and it surely is better to err on the side of caution, I cannot comment on the alternative options of tablets as I only have experience of Bisoprolol but I have had a bypass and 2 stents fitted so confirmed heart problems.
I am amazed they feel that excluding treating patients because of anxiety is a fair thing to do? I'd like to meet the people who are NOT anxious pre angiogram!
I always find it frustrating to get letters like this on a Saturday when you cannot do anything until Monday but I would start off speaking to your GP who will tell you what your options are.
"I'd like to meet the people who are NOT anxious pre angiogram"
Err, that would be me when I had mine during my heart attack. Of course, under the circumstances I had to let them do what they needed to do. The absolute professionalism of the doctors and their team really stood out, so I was totally calm and relaxed. Would I have one again under non-emergency circumstances? Definitely yes. I'd rather know whether I had a problem than not.
Indeed, it is a real shame that standards are not uniform across the NHS. The paramedics attending my 999 call actually asked whether I was happy to go to a hospital about 10 miles from my home as it had a dedicated cardiac unit with a cath lab rather than to A and E at my local hospital. Thankfully the doctors there agreed to fit me in and I went straight from the ambulance to the lab. I was in recovery 90 minutes after calling 999..... and being asked what I wanted for lunch. The process could not have been smoother.
I wasn't at all anxious having an angiogram right after my heart attack yet oddly when I had to go back for a second one, I was a wreck. The nurses were completely understanding . I had sedation both times- they always give sedation.
I would guess those of us who had an 'appointment' for an angiogram are more likely to experience anxiety pre the process than someone having one as an emergency.
The trouble is when you have to wait you experience all sorts of thought (never good ones)
Perhaps I should have clarified this.
I would think someone having a heart attack is anxious enough without worrying about having the angiogram.
Having followed this thread, I can say I 'was' one of the people who had an emergency angioplasty whilst mid STEMI HA & I can say I'd have agreed to being thrown off a building if it would have helped to save my life (2 stents fitted).
Then 36 hrs later another angioplasty to further open up another dangerously compromised artery (5 stents fitted).
Yes, absolutely, I was nervous the second time, I knew what was coming and had time to consider all the possible outcomes. Yes I've suffered from anxiety in the past but against something that could/has saved your life........
I remember seeing my arteries from the inside, live on screen using an intravascular ultrasound, now that's only available during an angioplasty, no other test can show this other than IVUS.
Hopefully common sense will prevail for all parties.
I have (a kind of) coping strategy for dealing with stressful situations including going to the dentist (which I hate)
I know this will sound odd but I put myself in a kind of trance and block out everything around me. I have done this since I was a youngster, I am often asked 'are you okay'.
I cannot say how I do this, maybe it has come with practice, it doesn't stop the worry before hand but when I am actually there I shut everything out until it is over, I still want all the sedation possible though!!
It didn't work as well as it had when I was having the rotablation though! I did thank them all at the end and said I wasn't coming back again, they had the last laugh when 8 hours later I was back with the staff again for a further angiogram as there was a little concern over the ECG (It turned out okay) As I said, I would have another if needed, I would have more stents or another bypass if that is what it takes to save my life.
I'm with you with regards the dentist. I'm sure they keep you waiting until the very last bit of courage has ebbed away, before you're called in!
Just typical they had the last laugh though, with your procedure!
During my second angio, which took much longer, the surgeon & I were chatting away, and I was asking questions which he was more than happy to explain, really surreal, as I said I was watching all this live, not for everyone & I could have just as easily not seen it. They're happy to accommodate either way. After all, it's in everyone's best interest for everything to go as smooth and hassle free as possible. Anxieties and requirements need to be acknowledged and understood by both sides before anything happens, we're all human, with the same frailties and characteristics.
But if it can save/prolong /improve our little lives then......
Before my first angiogram my cardiologist asked what music I liked, I had just been listening to Adele so said her, they played her music in the background, it did help a little. However I did hear him say 'that's interesting' so knew there was some bad news on its way! 😜
Actually any anxiety I had evaporated once the paramedics arrived. The guys were absolutely brilliant and had the situation under control very quickly.
It's anxiety about the procedure rather than general. Also anxiety about the likely result of the investigation. My mother, father (aged 50) and brother(aged 47) all died of strokes so it's a sensitive issue for me. I don't think it's reasonable to deny someone a procedure because of anxiety or asking questions.
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Hello
I know I am butting in when you have replied to someone else but because I relate to you on your reply I wanted to try and help
I seriously was a wreck about the procedure and I did not want any bad news either and we have a history of heart attacks and Bypasses in my family
But then I got to a stage where I had to say to myself but if there is something wrong they are so experienced now they can do something and yes I needed a triple Bypass and was horrified but had I not had the angiogram done I might not be here replying to you today
Please trust me when I say they told me they had never seen anyone with anxiety like mine but I did it so I know you can
You are afraid of maybe been like your relatives , dying young yet this angiogram is the one thing that can prevent that happening
Do not let anxiety win and rob you of this and if you go ahead which I hope you do then post and we will all do our best to help you get through it
We have had many post that they are petrified of an angiogram and they could not do it members gave them support and the next minute they are posting they did it and saying it was not as bad as they thought
Please face that fear and do it this is your life you have to do everything you can to protect it x
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Thanks for your very considerate reply. I’m willing to do the procedure with some sedation. The issue now is that they are not offering one. This is now the main concern since, as your own experience shows, I could be going around with dangerously blocked arteries. I get mild/moderate chest pain if I walk for about 400m. I don’t know how dangerous that is.
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Hello
Talk to your Doctor tell them your version of events including how you feel with your fear and ask if they will refer you again
I think you were right in your first post when you said the actual procedure is nothing like the patient imagined. My husband, who was beside himself with worry about his heart, just refused sedation (it was offered to everyone in the waiting room) as he wanted to be aware of what was going on and what the results were (I wasn't allowed in the room!).The only minor problem he had was bleeding from the entry point which was stopped by 10 minutes compression. Jan xxx
What you haven't told us is whether you were asked to sign the consent form which allows them to proceed. If you were offered it but didn't sign they can't proceed. In which case they will presumably pass you back to primary care i.e the GP. Unfortunately there are is a huge pressure on NHS waiting lists and if people forego their opportunity for investigations or treatments for whatever reason, however unfair it may seem, they will be passed by so that others can take their place.
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I didn’t refuse to sign. We didn’t get to that stage. I was told at the hospital that I should speak to the consultant who should offer another procedure. However, the consultant has indicated that there is “nothing more he can do”.
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I'm afraid time with health care professionals is metered, particularly within the NHS at the present time. If the medics believe they have given you your fair share of that time or even more and your situation has not been resolved because you are holding things up you will be sidelined, with suitable safeguards. I suspect that has happened to you. All I can suggest is you talk your position through with your GP, who may be able to recover the situation with the hospital, provided you demonstrate you are committed and it is clear you are happy to proceed without further ado. If you are not I fear you will not get much further than where you are at present.
They have not proposed any further procedure. I didn’t refuse the procedure in principle.
I’m afraid your comment ‘no worse than a trip to the dentist’ does not ring true for all! Mine was painful and after several attempts to insert tube into my ‘very small veins’ (his words) in my wrist I insisted on more pain relief, the Consultant was very impatient and afterwards I told him so. I had the procedure 8 years before and a stent with no problems whatsoever. He apologised!
You have been treated very badly which kind of makes my sorry post all the more appropriate. I have never had any form of mental health problem till now and now I understand far more how people actually feel. Many will tell you that angiogram is no problem and not painful and that is very true but then for you your fear will tell you other wise.It’s so important to get it done all the tests I had showed nothing till I had the angiogram and bang it was that bad I didn’t go home, I needed a quadruple bypass asap. Speak to your GP ask to be seen at a different hospital it’s your right. If everything fails and I know you shouldn’t have to do this but go private it’s around £2,000 and you’ll get exactly what you want but please please get it done after my experience if I hadn’t of had it done it would not have been found and my outcome would have been very different, it’s only been 7 weeks since my surgery but I don’t think I would have been here now.
I'm afraid 'going private' does not necessarily guarantee the risks associated with any procedure will be different than in the NHS. Very often the resources and equipment are identical and the people doing those procedures are the same. So if a procedure is going to painful it matters not where it is carried out. What is different between private care and the NHS however is that the level of personal care given to patients is much better, and things get done quicker .
I agree with you, but the thing is it’s a must to get it done it’s so important and really the answer is you have to overcome your fear regardless or you could end up dead. The thing is the staff could have sedated him especially if this was prearranged as for going private you will definitely be able to be sedated and talk through everything. If stents are required and you can afford it then they can still be done privately but if you go back to the nhs you would at least know what to expect when the stents are done.I personally have no problem with any test or anything that needs doing but many people do any they need that extra support, I hate the dentist it takes me ages before I can get my self there.
I considered paying privately for an angiogram to try and speed things up ... in the event I didn’t need to as my cardiologist got me an urgent one - I was struggling to accept a lengthy wait and just wanted to know what was wrong after being poorly for a long time . I was anxious but not over anxious - in the event I found the procedure nothing to worry about , honestly ! The four of us on the ward walked in , barely half an hour later 3 walked out , I had to be transferred onto bed as so sleepy - I don’t think I could have received any better care / treatment privately , the staff were so reassuring and caring.
I too was refused sedation when my ICD was replaced despite requesting it. After the procedure when I screamed with pain the surgeon said next time I should have sedation!As for all this nonsense about time constraints, the surgeon strolled in to the theatre and enquired how many patients. He was told only two. So he obviously had not read their notes and could have fitted more in.
I had no pre assessment and in theatre they carried out a test which meant the surgeon rang up my consultant to see if he should proceed. This test should have been done prior to the operation.
To add insult the letter to my GP said all had gone according to plan…
There are lots of backgrounds ins and outs to this but clearly an angiogram isn't offered lightly. At the end of April i had pains, attended the assessment clinic the same day and to cut a long story short didn't leave hospital for 2 weeks, after having had an angiogram with the expectation of an adjustment to medication or at worst a stent . I had previously been diagnosed a decade ago with angina and until then well managed.
The angiogram showed almost total furring up of arteries and the triple bypass needed turned into a quadruple bypass. The two weeks in hospital, partly because of lack of beds after the operation, primarily due to pressure on our region due to an influx of tourists and that many of our 'cottage' hospitals had closed thereby causing 'bed blocking' as no one was available to look after those individuals after intensive care, once thrown out of hospital, often too early.
So my advice is that you need to do whatever it takes, eating humble pie, adjusting your expectations, being quietly insistent or whatever, as the adjustment in medications proposed might mask something more underlying and urgent..
You need to know what is up and so do the medical authorities if you are to be treated.
I have an irrational fear of needles. But I honestly felt nothing when I had an angiogram. I do not even know where the needle went. Possibly behind my ear. Probably in my arm.
Samazeuilh, perhaps you could start at the beginning and quietly work through.
I did go private, because nothing else was available. So it was a private hospital and not just a private consultant.
When you say ‘the aborted angiogram’. Did the Hospital start one angiogram, but abort it, or did they refuse to start?I think you are saying, they refused one because (for whatever reason) you did not halt your Apixaban, in advance, the other because you needed someone with you for 24 hours afterwards.
Did you discuss sedation at your pre-assessment? Did they tell you it was too risky in your case?
I have had 11 angiograms, two different Hospitals, and each time I have a pre-assessment and I am taken through the arrangements I need to make myself, in advance, and then given written materials to take away.
If you are very anxious at the pre-assessments you may not hear, or remember, the instructions. I write down questions beforehand and the answers and when allowed, take a friend to listen for me.
My view? The dreadful current pressure on hospitals and the distressing wait for essential procedures, causes serious risk and person pressures on waiting patients. We need to play our part in meeting necessary requirements before we use up a costly slot for such procedures.
You raise some good points. The angiograms were not started then abandoned -"aborted" was a poor choice of word on my part. Providing written instructions sounds like good practice. I was given leaflet but there were no hand- written instructions (I presume that's what you mean) regarding pausing Apixaban. They didn't say I was not suited for sedation. The sedation was, apparently, only 5mg of Diazepam (aka Valium) administered intravenously.
Thank you. No, I mean written materials which I’m always given at Pre-assessment. I’m sure you know Apixaban is an anticoagulant which is usually mentioned, but we are told to ring in and check in advance, if on an unmentioned anticoagulant.If they will give you sedation, and you say you can arrange a 24 hr ‘friend’ afterwards, and you agree to stop Apixaban, in advance, then I think there might be a fair chance of allocating another slot to you. They will want to be sure a slot will not be wasted.
Try too think positive not negative ,your fears are making you over think. I was scared too, but everything went smoothly felt very little pain when the needle went in , then never felt a thing,i watched most of the procedure on tv and chatted to the doctor. I'm sure you will be fine don't let what hasn't happened to you worry you.
The common reason for not giving a sedative is that if a patient has come by car , driving themselves, then it is illegal for them to drive after the procedure while under the influence of a sedative. This is why the question of who is with you is relevant, as patients can ignore the advice that they cannot drive, have an accident, and the hospital is then liable
Sorry for your anxiety over angiograms. My husband at present is waiting for an urgent angiogram which he probably won't get until September. Time in the Cath lab is precious so it would be good to get all your fears and questions ironed out before you go in. There is a waiting list for the procedure and I know my husband is desperate to have one again as he is getting bad chest pain. I can understand your fears however I also understand the consultant as he has time constraints and there are people waiting for this procedure. Take care
Hi, I am so sorry to hear ofthis awful experience. I once had similar with a bladder of and an arrogant surgeon didnt like my questions so almost refused to operate. Its an horrendous situation as a very emotional time.I would encourage you to chat with the BHF nurses, to get your questions answered and reassure you. Then chat to your GPwhen you are feeling reassured & can show you are less anxious. You could ask for a referral /2nd opinion but this may take time.
I was already in hospital when I had my angiogram, and very ill, but can say I was very very well looked after though it was not a pleasant procedure it is so vital & valuable to get an accurate diagnosis.
I am on bisoprolol and after the 1st month, while my system got usedto it, Ive had no issues with it. Wishing you all thebest.
I have not read date of your post. I have had all possible tests, angiogram etc under anxious circumstances, I was told I would need another angiogram after diagnosis of heart failure (already have pacemaker) Consultant wanted me to have Non invasive angiogram this is CTscan of heart , I went along with this as only a few hospitals have specialised equipment for this and radiographers. I was offered one at a private hospital via NHS So quick but thorough ten mins in all. I register 100% with anxiety If you havent had usual angiogram ask about CT non invasive heart one. Good luck with everything, I also take bisoprolol twice daily along with maby more meds, found it good.
In fact, the specialist nurse who I saw months ago originally referred me for a CT angiogram and a nuclear profusion test. She then rang me on my way home to say that the consultant wanted to do an invasive angiogram. When I spoke to the consultant he said the CT test would not be accurate enough. Even if that is so it would be a better alternative than doing nothing as he is doing at the moment.
Hello. I’ll preface my reply by apologising first if it seems a bit blunt. You’ve got to get out of your own way.
A blame game now isn’t going to help you.
Some very helpful comments above, I still see defensiveness in some of your replies.
The pre assessment would have covered the stopping Apixaban and 24 hr watch after a stent so if you forgot these things it’s because there is a fundamental issue with how you are approaching a potentially life saving procedure.
It really doesn’t matter now who is right or wrong, if you approach this in a calm non confrontational manner you are far more likely to get the angiogram you need.
Now I’ve made it sound so easy haven’t I?
I know it’s not, anxiety is a murderer. My own situation involved a divorce, enforced house sale, estrangement from wider family along with ill health and heart issues including two angiograms. I live alone so had the same problem getting 24hr support. So my stress and anxiety levels were through the roof. I’ve been there.
This forum is brilliant but you need one on one support. My advice is to spend a couple of hundred pounds on a few sessions with a therapist and take it from there.
You need to win this battle but it doesn’t mean someone else has to lose.
Thanks for your reply. I have the specific objective of getting the procedure carried out-I don't want to get involved in a protracted dispute with the hospital but will do do if it's necessary. I haven't said this before, but this is a hospital which was on special measures for years until fairly recently. The inspectors identified serious shortcomings in terms of the way patients were treated over years as well as issues over record-keeping.
Regardless of that being true, you are still denying - and now, deflecting - all and any responsibility on your own part. You have a decision to make. Regardless of how difficult that decision may or may not be for you personally, no-one including your Cardiologist can ‘do anything’ more than they’ve already tried to do for you unless and until *you* take your decision. Until then, I’m afraid you are the one tying the Cardiologist’s hands behind his/her back, leaving them no better option than the one and only best option they’re now left with for you: to treat you ‘as if’.
Surely, it’s better to find out what’s going on once and for all, and to have the treatment you need.
I want to have the procedure. I don’t consider blame is pertinent here. The issue is duty of care to the patient. As stated earlier, the hospital has been on special measures and has a track record of this sort of thing.
Hi I am sorry to hear you have had this experience! I get frustrated when a letter does not relay the true situation: and I hear it was simply a matter of your wanting sedation and a few questions answered to go ahead: totally reasonable! is definitely not uncommon to be given sedation. In my case I opted not to but was anxious with questions and doubts as I sat and waited outside the theatre. The consultant came out and sat next to me and talked to me kindly to reassure me about going ahead. My sister had sedation for hers with no quibble. Do you have a good GP who listens to your story? Choose the best GP in your surgery and ask for repeat referral to a different consultant (or different hospital as someone suggested). You can also get a private appointment with a well reviewed consultant, then if you are 'self pay' they can request the angiogram on the NHS for you, often. Cardiologists are currently under a lot of pressure and they are short with the time they give now in my experience. They can be under a lot of stress. But you do need to push for what you want and deserve these days unfortunately, so be strong and assertive (in a polite, calm, persistant way) to get your needs met. It can be time & energy consuming but is worth it. Best wishes and keep us posted.
The angiogram really is the gold standard for visualising the coronary arteries. I had a STEMI 2 years ago. After they unblocked my RCA via an angioplasty, and another angioplasty, then put me on anticoagulants initially intravenously, then after discharge via rivaroxaban, clopidogrel, and aspirin. Because they did not know for sure if the artery was really clear. They (at my request) did a stress echo which was "probably OK"
I felt that there was a ticking time bomb so they grudgingly did an angiogram which showed a clot. So they removed it.
I really would do whatever you have to do including grovelling, no matter that some of the issues were not your fault.
I would be cautious about getting PALS involved, and make that a last resort
Was it a angiography you were to have or angiogram ! I was told I needed a angio but the consultant decided not to ! They decided a angiography and can I say it was brilliant just like a scan and it takes minutes. I am not a doctor as we all know we can only give opinion I know that you can ask for a second opinion from another consultant or hospital, I was delighted to have a angiography scan 👍🏻 I am sure you will get it sorted keep us posted
Presumably, there was some medical reason why you could not have a sedative for the procedure?
The doctors for my initial angiogram & stent and the second stent said most people are anxious about the procedure and require a mild sedative to calm them down. I was still aware the procedure was going on but concentrated on things like the movement of the table rather than what was going on inside me. I hate the thought of medical procedures, even blood-tests, and try to think of something else while it's happening.
Being shown around probably wouldn't help. At some point you have to accept that these people are doing this all the time and the important thing is they know what they're doing rather than you do.
YOu can most certainly ask for a second opinion. My GP just demanded one for me as he was so disgusted by a surgeon I saw. NO one should refuse to treat you because of anxiety. Were you refused sedation for the angiogram? That's ridiculous. IT's automatic where I have mine. I know it's stressful for you but you must put in a complaint and insist on going elsewhere
Dear you,
I am far from medically trained but after only knowing you for a while on here I can tell that anxiety is a massive part of your life and the way it controls you.
For the life of me I cannot understand why the angiogram team didn’t spend a little more time with you to answer your questions, I fully understand that most should have been answered at the Cardiologist point, but the team in front of you at that moment should have not only seen your anxiety { not that hard to see in someone, trained or untrained } but should be trained in dealing with it.
Two more difficult patients { special needs, were in front of me, not saying that you are difficult } and they were reassured via their carers and they had the operation.
As for the pre-med well that sounded like a communication error and I was told to make sure that I didn’t drive but no mention of anyone at home { which there wasn’t at the time }
Above all I understand your frustrations at the way you were treated, as for your med changes then only your Dr/Cardiologist can answer that and knowing the little I do about you I am sure that you will ask the questions needed.
Just to say that the consent letter highlights the extreme consequences of an angiogram can be a stroke or heart attack it makes sense that you should be with someone for at least 1 night after it has been done.
As a single woman I know this can be difficult, I know I am lucky to have family who will help out, though being extremely independent I don't like doing it.
I was one of the unlucky ones who had a stroke 4 days after the angiogram but recovered very quickly so have very few after effects. I went on to have a bypass with very little problems.
This was an added worry when I needed to have a further 2 angiograms nearly 5 years later and required 2 stents fitted by drilling (which was very unpleasant!) Luckily they told me at the start I could have sedation if I wanted it (what a silly question) I can tell you when I was having the rotablation procedure I heard the Drs say, 'more fentanyl' which was inserted via the cannula in the back of my hand.
So warts and all that has been my experience of having an angiogram, not at all pleasant - would I have another one? Without doubt, as after both procedures (bypass and stents) my quality of life improved.
I think we are all anxious to some degree. I tried to channel the anxiety into what would likely happen if I didn't have the angiogram and later on if I didn't have the CABG. Bad outcomes that make the small risk that remedial procedures carry seem like the far more favourable option.
The letter really did not seem angry to me....the letter seemed very straightforward - the doctor laid out the facts, as he sees them, and made a recommendation. Did they give you any medical reason for not wanting to give you a sedative - would it interfere with the test in any way based on your particular condition?
I don't think the letter was angry. It was, however, inaccurate and denies me a procedure which is needed. Further, it tampers with long standing medication when there is no reason to do so. The doctor has not given me any feedback on the abnormal ECG either.
So everything that went wrong the first and second time can be easily corrected. This is good. However, now you have to convince them that "third times the charm". You will most likely have to do this by getting your primary care physician involved. Doctors do not like it when patients do not listen to their instructions and they really don't like it when they consider a patient "uncooperative". They are thinking that two other patients who needed their services could have been helped during the two failed appointments. I am totally sympathetic about the anxiety issue - I was sent home before a thyroid biopsy was done because my blood pressure was too high! (I had to get my primary care doctor to prescribe more blood pressure medication AND waited a month for the second appointment AND my blood pressure wasn't so great the second time, but at least it was within the guidelines for being able to do the procedure). Regarding the change of medication, the angiogram doctor feels strongly about bispropolol as a better drug for you, but your primary care physician will have a say in that also, so you really need to see him or her as soon as possible.
You are absolutely right about seeing the primary care physician and getting them on board. My approach will be fairly low key initially- I will speak to PALS and the GP -but I will make it clear that I am expecting them to rectify the situation within a reasonable timeframe.
in reply to
I suggest a little humility might get you further along rather than telling them what you expect, especially since some of this situation appears to be down to to you, and that particularly applies to your discussions with your GP who you need on your side. But should you find you are able to return to the hospital be aware that a 'reasonable time frame' could be months away unless you are classed as an urgent case. I assume you are currently effectively discharged from the hospital and if you are re-instated that may mean going to the back of the queue. For your info I am also waiting for an angiogram which was supposed to be 8-10 weeks on from my consultation with the cardiologist, and when I spoke to 'appointments' recently I was told I may have an appointment in about two months time which mean six months on from when it was set up, but even that is not guaranteed. And I imagine there are others who will be waiting longer than that. Although we think we are special and rightly so, we are really on a conveyor belt of 100s of anonymous people, so you have to accept that, and manage your expectations accordingly, which sometimes means you don't always get what you think you deserve.
I personally had an angiogram under sedation (privately) and recall little of itI had ablations under sedation which was a whole new ball game but presumptions they made are questionable in themselves
I just spoke to PALS who were not very inspiring. They said (and this was pretty well *all* they said) : "just put it in an email"; "I'm the only one in the office at the moment"; "I'm not medically trained"; "I can't guarantee to get back to you in five days" (the usual timescale).
Put it in writing as they do need that and mark it as urgentDon’t know which area you are from but I did get a good response from the ones I dealt with
If speaking on the phone always get the name of who you spoke to and make a complaint diary yourself of date times etc if you don’t hear by Friday chase again - unfortunately this is often the case but still follow through and also write to your GP with your concerns and maybe ask for an appointment with them to talk all this through and maybe get re-referred back (maybe even a different consultant) - good luck tho
I’m drafting a letter to PALS at the moment. I have a GP appointment on Wednesday. I’m hoping that one I the two will resolve the problem. The immediate issue is getting another procedure booked.
HiI was wondering if you were offered a CT Coronary angiogram? I had one because I didn’t want an invasive procedure unless absolutely necessary. I had it and it showed atherosclerosis then after a Dobutamine stress test it was decided not to stent as blood was flowing normally snd was put on aspirin and statin.
Isnt it strange how consultants differ in opinion. Well thanks to my CT Angiogram I was also diagnosed with an 8cm tumour in the chest in front of my heart so it saved my life. Good luck
You are spot on, as I know to my cost. Many years ago, my husband died on the operating table as the result of an error made by the surgeon. It was a routine operation and performed in a private hospital.
I am confused. You said they had refused two angiograms, but then you said you had had an angiogram. Also, a general question. I know everyone is different, but why is everyone so worried about bisoprolol? I’ve been taking 10 mg of bisoprolol for years, as well as spironolactone and candesartan, aspirin and a statin, without any problems. My cardiomyopathy is now stable from this medication. Best wishes for getting your anxiety under control. I know, from past experience, that anxiety can produce heaps of nasty symptoms.
The experiences we receive under these skilled people is mostly wonderful, but ability to listen to the patient and put them at ease is what separates the good from the great. My consultant who carried out the triple bypass I needed after was the best, but both him and the nurses who saw me after the angiogram, agreed that the ‘bedside manner’ of Mr X was well known to be poor. Of course I’d put myself through any procedures again if needed to prolong life and I find it poor taste for you to suggest otherwise!
That is an awful experience, I feel for you. It IS an anxious situation. When I was ready for the insertion, a kind assistant asked if I was ok, so I said no, and he offered 5mg Diazepam in my drip. YES PLEASE I said, and the procedure went ahead. I was so chilled out I had to stay in recovery quite a while! I took 5mg Diazepam tablet (thanks Mum) before entering the MRI tube too, as I'm claustrophobic. I suggest you ask for Diazapam from your GP, ready for next time. Good luck.
I think the issue with sedation was the op hadn't arranged to have someone with them overnights afterwards which precludes them giving any sedation, it is a condition of getting some.
"Sorry, but you are just not getting this are you? What the two replies to your latest comment from Lowerfield and Pecansandie are trying to say in a roundabout way is that you need to realise that for whatever reason, be it anxiety, forgetfulness or constant questioning, you have probably been largely responsible for the fact you have not had the procedure that they offered. "
As I explained, asking questions is not a legitimate reason for denying a procedure nor is anxiety, nor, for that matter, is what you term "forgetfulness". If they were, vast numbers of people would be excluded from treatment.
" For your own sake you need to start looking at this from their point of view - the vast majority of procedures go ahead fine as long as the patient co-operates. Take it from me, you absolutely need to have this procedure, which could well save your life, so I suggest to facilitate that you need a bit of a change in attitude. If I were in your boots now I would be getting myself into grovelling mode. I would do anything to have that Angiogram - it's up to you!"
I don't think "grovelling" is a good strategy; as they are in the wrong it's not something I will be doing.
I actually don't think the staff at the hospital can be called to account if they followed guidelines so not sure attack is the best strategy.
As others have said I would present myself to the GP to discuss the letter and throw myself at their mercy and start telling them the things you intend to do that ensures the angiogram goes ahead.
I have a lot of sympathy for you as it can be a scary experience but just think how much more anxiety you are now bringing to the table.
You obviously feel an angiogram is the best way forward for you, as far as the NHS are concerned they arranged 2 for you and were ready to go, it was you who actually put up the hurdles.
Bite the bullet, ask the GP what can be done to get you back on the list and what you can do to ensure it goes ahead.
Good luck.
“It seems everything is everybody's fault except the op.”
I didn’t say that. My specific concern is the withdrawal of the procedure and the risk that entails. That’s a perfectly reasonable concern.
I explained before that the hospital is one that has been on special measures and is now on notice to improve. My rather negative perception of aspects of its performance is widely shared in the area where I live.
“Now it's PALS that weren't very inspiring. “
Because they weren’t. The comments were not helpful and they sounded disinterested. It’s not what you expect from an organisation which is supposed to be helping patients.
“People have answered your queries, gave advice and their own experiences of overcoming anxiety yet you still come up with more negatives and blame. “
In fact I said that I appreciated many of the comments in an earlier post and have acted on some of the constructive suggestions.
“I might be in the minority here but I think you are quickly losing the forum sympathy.”
I’m not sure that you speak for the forum. Not am I necessarily seeking “sympathy”. As I said, I appreciate many of the positive suggestions and good ideas offered by people here and will be acting on them.
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